TY - JOUR
T1 - Proton therapy radiation pneumonitis local dose-response in esophagus cancer patients
AU - Echeverria, Alfredo E.
AU - McCurdy, Matthew
AU - Castillo, Richard
AU - Bernard, Vincent
AU - Ramos, Natalia Velez
AU - Buckley, William
AU - Castillo, Edward
AU - Liu, Ping
AU - Martinez, Josue
AU - Guerrero, Thomas
N1 - Funding Information:
We extend our warmest gratitude to the thoracic radiation oncologists, thoracic surgeons, and gastrointestinal medical oncologists at M.D. Anderson whose patients comprised this study. This work was partially funded by the National Institutes of Health through a National Cancer Institute Grant R21CA141833 and through an NIH Director’s New Innovator Award DP2OD007044 . RC was partially supported by an NIH Training Grant T32CA119930 .
PY - 2013/1
Y1 - 2013/1
N2 - Purpose: This study quantifies pulmonary radiation toxicity in patients who received proton therapy for esophagus cancer. Materials/methods: We retrospectively studied 100 esophagus cancer patients treated with proton therapy. The linearity of the enhanced FDG uptake vs. proton dose was evaluated using the Akaike Information Criterion (AIC). Pneumonitis symptoms (RP) were assessed using the Common Toxicity Criteria for Adverse Events version 4.0 (CTCAEv4). The interaction of the imaging response with dosimetric parameters and symptoms was evaluated. Results: The RP scores were: 0 grade 4/5, 7 grade 3, 20 grade 2, 37 grade 1, and 36 grade 0. Each dosimetric parameter was significantly higher for the symptomatic group. The AIC winning models were 30 linear, 52 linear quadratic, and 18 linear logarithmic. There was no significant difference in the linear coefficient between models. The slope of the FDG vs. proton dose response was 0.022 for the symptomatic and 0.012 for the asymptomatic (p = 0.014). Combining dosimetric parameters with the slope did not improve the sensitivity or accuracy in identifying symptomatic cases. Conclusions: The proton radiation dose response on FDG PET/CT imaging exhibited a predominantly linear dose response on modeling. Symptomatic patients had a higher dose response slope.
AB - Purpose: This study quantifies pulmonary radiation toxicity in patients who received proton therapy for esophagus cancer. Materials/methods: We retrospectively studied 100 esophagus cancer patients treated with proton therapy. The linearity of the enhanced FDG uptake vs. proton dose was evaluated using the Akaike Information Criterion (AIC). Pneumonitis symptoms (RP) were assessed using the Common Toxicity Criteria for Adverse Events version 4.0 (CTCAEv4). The interaction of the imaging response with dosimetric parameters and symptoms was evaluated. Results: The RP scores were: 0 grade 4/5, 7 grade 3, 20 grade 2, 37 grade 1, and 36 grade 0. Each dosimetric parameter was significantly higher for the symptomatic group. The AIC winning models were 30 linear, 52 linear quadratic, and 18 linear logarithmic. There was no significant difference in the linear coefficient between models. The slope of the FDG vs. proton dose response was 0.022 for the symptomatic and 0.012 for the asymptomatic (p = 0.014). Combining dosimetric parameters with the slope did not improve the sensitivity or accuracy in identifying symptomatic cases. Conclusions: The proton radiation dose response on FDG PET/CT imaging exhibited a predominantly linear dose response on modeling. Symptomatic patients had a higher dose response slope.
KW - Positron emission tomography
KW - Proton therapy
KW - Radiation pneumonitis
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U2 - 10.1016/j.radonc.2012.09.003
DO - 10.1016/j.radonc.2012.09.003
M3 - Article
C2 - 23127772
AN - SCOPUS:84874660870
SN - 0167-8140
VL - 106
SP - 124
EP - 129
JO - Radiotherapy and Oncology
JF - Radiotherapy and Oncology
IS - 1
ER -